Prevalence, Correlates, and Outcomes of Omphalocele in the United States, 1995-2005
Prevalence, Correlates, and Outcomes of Omphalocele in the United States, 1995-2005
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DOI：
10.1097/aog.0000000000000920
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发表时间：
2015-08-01
影响因子：
7.2
通讯作者：
Kirby, Russell S.
中科院分区：
文献类型：
--
作者：
Marshall, Jennifer;Salemi, Jason L.;Kirby, Russell S.
目的：利用美国国家出生缺陷预防网络1995-2005年的数据，研究脐膨出的流行趋势、流行病学相关性和1年生存率。方法：我们从12个州以人口为基础的出生缺陷登记处检查了11年来2308例脐膨出。我们使用泊松回归来估计脐膨出的患病率和危险因素，使用Kaplan-Meier生存曲线和Cox比例风险回归来分别估计生存模式和风险比，以检查孤立病例与非孤立病例的比较。结果：脐膨出的出生患病率为1.92 / 10000活产，没有一致的趋势。患有脐膨出的新生儿多为男性（患病率为1.22,95%可信区间[CI] 1.12-1.34）、母亲年龄大于或大于35岁（患病率为1.77,95% CI为1.54-2.04）、年龄小于20岁（患病率为1.34,95% CI为1.14-1.56）以及多胞胎（患病率为2.22,95% CI为1.85-2.66）。脐膨出新生儿先天性心脏缺陷的比例最高（32%）。婴儿死亡率为28.7%，其中75%发生在出生后28天内。孤立病例的生存率最高，染色体缺陷新生儿（风险比7.75,95% CI 5.40-11.10）和低出生体重新生儿（风险比7.51,95% CI 5.86-9.63）的生存率最低。结论：1995 ~ 2005年脐膨出的发病率基本保持不变。母亲年龄（小于20岁和大于35岁）、多胎妊娠和男性是脐膨出的重要相关因素，而染色体缺陷和出生体重过低是这些新生儿1年生存率的一致决定因素。证据水平：ii
OBJECTIVE: To examine the trends in the prevalence, epidemiologic correlates, and 1-year survival of omphalocele using 1995-2005 data from the National Birth Defects Prevention Network in the United States.METHODS: We examined 2,308 cases of omphalocele over 11 years from 12 state population-based birth defects registries. We used Poisson regression to estimate prevalence and risk factors for omphalocele and Kaplan-Meier survival curves and Cox proportional hazards regression to estimate survival patterns and hazard ratios, respectively, to examine isolated compared with nonisolated cases.RESULTS: Birth prevalence of omphalocele was 1.92 per 10,000 live births with no consistent trend over time. Neonates with omphalocele were more likely to be male (prevalence ratio 1.22, 95% confidence interval [CI] 1.12-1.34), born to mothers 35 years of age or older (prevalence ratio 1.77, 95% CI 1.54-2.04) and younger than 20 years (prevalence ratio 1.34, 95% CI 1.14-1.56), and of multiple births (prevalence ratio 2.22, 95% CI 1.85-2.66). The highest proportion of neonates with omphalocele had congenital heart defects (32%). The infant mortality rate was 28.7%, with 75% of those occurring in the first 28 days. The best survival was for isolated cases and the worst for neonates with chromosomal defects (hazard ratio 7.75, 95% CI 5.40-11.10) and low-birth-weight neonates (hazard ratio 7.51, 95% CI 5.86-9.63).CONCLUSION: Prevalence of omphalocele has remained constant from 1995 to 2005. Maternal age (younger than 20 years and 35 years or older), multiple gestation, and male sex are important correlates of omphalocele, whereas co-occurrence with chromosomal defects and very low birth weight are consistent determinants of 1-year survival among these neonates.LEVEL OF EVIDENCE:II